PORTABLE CAMERA AIDED SIMULATOR (PORTCAS) FOR MINIMALLY INVASIVE SURGICAL TRAINING

The present disclosure is directed to a system and method for surgical training with low cost, reusable materials and a highly customizable virtual environment for skill-building. According to various embodiments, a surgical training tool is usable in conjunction with a support structure configured to at least partially constrain the tool movement. Meanwhile, the tool is tracked in real-time with off-tool detectors to generate a tool path driving a virtual rendering of the surgical training tool in an operative environment. The virtual rendering may be visually observable via a display device and may include a customizable and/or selectable operative environment with one or more structures that can be operated on by the virtual surgical training tool. By tracking the virtual tool interaction with the virtual structures, a task path may be established for documenting and/or objectively assessing the performance of one or more operative tasks

Single-Site Colectomy With Miniature \u3ci\u3eIn Vivo\u3c/i\u3e Robotic Platform

There has been a continuing push to reduce the invasiveness of surgery by accessing the abdominal cavity through a single incision, such as with laparoendoscopic single-site (LESS) surgery. Although LESS procedures offer significant benefits, added complexities still inhibit the procedures. Robotic surgery is proving to be an excellent option to overcome these limitations. This paper presents the experimental results of the single-incision in vivo surgical robot (SISR), a multifunctional, dexterous, twoarmed robot capable of performing surgical tasks while overcoming the issues associated with manual LESS operations. In vivo surgical procedures have been used to demonstrate the efficacy of using a robotic platform over traditional laparoscopic tools. The most recent experimental test resulted in the first successful in vivo robotic LESS colectomy utilizing a robot completely contained within the abdominal cavity. In this test, SISR showed significant benefits including access to all quadrants in the peritoneal cavity and improved dexterity

In vivo laparoscopic robotics

AbstractRobotic laparoscopic surgery is evolving to include in vivo robotic assistants. The impetus for the development of this technology is to provide surgeons with additional viewpoints and unconstrained manipulators that improve safety and reduce patient trauma. A family of these robots have been developed to provide vision and task assistance. Fixed-base and mobile robots have been designed and tested in animal models with much success. A cholecystectomy, prostatectomy, and nephrectomy have all been performed with the assistance of these robots. These early successful tests show how in vivo laparoscopic robotics may be part of the next advancement in surgical technology

METHODS, SYSTEMS, AND DEVICES FOR SURGICAL ACCESS AND INSERTON

The various embodiments herein relate to systems, devices, and/or methods relating to Surgical procedures, and more specifically for accessing an insufflated cavity of a patient and/or positioning Surgical systems or devices into the cavity

Long Term Outcomes of Surgical and Clinical Symptoms Following Minimally Invasive Heller Myotomy: A Retrospective Clinical Database Review

I Introduction Minimally invasive Heller myotomy rates have increased, but little evidence is available regarding long term clinical and surgical outcomes. Our aim was to evaluate long term symptom improvement and medication resolution for patients undergoing minimally invasive Heller myotomy. Methods A single-institution database was retrospectively reviewed for patients undergoing laparoscopic Heller myotomy (LHM) or robotic Heller myotomy (RHM) during 2007-2018. Patients with primary HM followed by a Dor fundoplication were included. Demographics and surgical data were analyzed. Esophageal symptoms, testing, and medication use were collected preoperatively (pre-op), at 6-month (6-mo), 12-month (12-mo), and long-term (LT; 12-mo+) follow-up. Analysis was performed using SPSS v.23.0, α=0.05. Results Eighty eight patients (RHM:N=66; LHM:N=22) were included. The majority were male (62.5%) and Caucasian (89.8%), with a mean BMI of 27.3. Two patients had an intraoperative esophageal perforation, each repaired with a non-eventful postoperative course. Mean follow-up time was 71 months overall, 75 months [11-171 months] and 40 months [6-158 months] for LHM and RHM, respectively. All patients showed significant LT improvement of regurgitation, solid or liquid dysphagia, and Eckardt Score. Postoperative proton pump inhibitor (PPI) use was significantly lower at LT (LHM:31.3%, RHM:19.4%) compared to pre-op. Conclusion In this study, minimally invasive HM was a safe and effective treatment for achalasia symptom resolution in the long term. Therefore, in our experience, minimally invasive HM is a safe therapy that helps maintain symptom resolution

In vivo laparoscopic robotics

Robotic laparoscopic surgery is evolving to include in vivo robotic assistants. The impetus for the development of this technology is to provide surgeons with additional viewpoints and unconstrained manipulators that improve safety and reduce patient trauma. A family of these robots have been developed to provide vision and task assistance. Fixed-base and mobile robots have been designed and tested in animal models with much success. A cholecystectomy, prostatectomy, and nephrectomy have all been performed with the assistance of these robots. These early successful tests show how in vivo laparoscopic robotics may be part of the next advancement in surgical technology

End-Effector Contact and Force Detection for Miniature Autonomous Robots Performing Lunar and Expeditionary Surgery

Introduction: The U.S. Space Force was stood up on December 20, 2019 as an independent branch under the Air Force consisting of about 16,000 active duty and civilian personnel focused singularly on space. In addition to the Space Force, the plans by NASA and private industry for exploration-class long-duration missions to the moon, near-earth asteroids, and Mars makes semi-independent medical capability in space a priority. Current practice for space-based medicine is limited and relies on a “life-raft” scenario for emergencies. Discussions by working groups on military space-based medicine include placing a Role III equivalent facility in a lunar surface station. Surgical capability is a key requirement for that facility. Materials and Methods: To prepare for the eventuality of surgery in space, it is necessary to develop low-mass, low power, mini-surgical robots, which could serve as a celestial replacement for existing terrestrial robots. The current study focused on developing semi-autonomous capability in surgical robotics, specifically related to task automation. Two categories for end-effector tissue interaction were developed: Visual feedback from the robot to detect tissue contact, and motor current waveform measurements to detect contact force. Results: Using a pixel-to-pixel deep neural network to train, we were able to achieve an accuracy of nearly 90% for contact/nocontact detection. Large torques were predicted well by a trained long short-term memory recursive network, but the technique did not predict small torques well. Conclusion: Surgical capability on long-duration missions will require human/machine teaming with semi-autonomous surgical robots. Our existing small, lightweight, low-power miniature robots perform multiple essential tasks in one design including hemostasis, fluid management, suturing for traumatic wounds, and are fully insertable for internal surgical procedures. To prepare for the inevitable eventuality of an emergency surgery in space, it is essential that automated surgical robot capabilities be developed

Разработка и валидация методики количественного определения силденафила и n-десметил силденафила с помощью ВЭЖХ-МС/МС в плазме крови человека

Aim. To assess bioequivalence of sildenafil citrate tablet formulation produced by pharmaceutical company “Microkhim” (Rubezhnoe, Ukraine) it was developed and validated a prompt, specific and quite simple method for quantitative determination of sildenafil and its active metabolite - N-desmethyl sildenafil concentrations in the human blood using deuterium labeled internal standards. Direct liquid-liquid extraction procedure was utilized to extract the analytes from the blood plasma.Methods. Contents of sildenafil and its metabolite in supernatant were determined by means of the high performance liquid chromatography / tandem mass spectrometric detection technique. Ionization of sildenafil, N-desmethyl sildenafil, sildenafil-d8 and N-desmethyl sildenafil-d8 was performed in the positive electrospray mode (ESI, Positive). Detection of the analytes was carried out in the multi reactions monitoring (MRM) regimen with the following m/z values for selected parent ions: 475,30; 483,20; 461,20 and 469,20, respectively. The daughter ion m/z value was selected to be 283,10 for all analytes.Results. Analytical method proposed proved to demonstrate reliable accuracy and reproducibility for both analytes and has been validated within linear range 5,05-1009,92 ng/ml for sildenafil and 2,24-400,84 ng/mL for N-desmethyl sildenafil with correlation coefficient (r2) equaled to 0.9975 and 0.9973, respectively.Conclusions. It was developed and validated a simple, specific and sensitive HPLC-MS/MS method for quantitative determination of sildenafil and its active metabolite N-desmethyl sildenafil concentrations in human blood plasma utilizing stable isotope labeled internal standards – deuterated sildenafil-d8 and N-desmethyl sildenafil- d8. Important feature of the method was a modified preanalytical procedures of biological samples preparation – direct liquid-liquid extraction that allowed to avoid laborious and time-consuming procedures such as evaporation to concentrate the samples with consequent recovery of dry residue, as well as to refuse from expensive solid-phase extraction. Application of the deuterium labeled internal standards allowed to suppress a biological matrix effect drastically, as well as to reach target LLOQ level. Experimental data obtained in the course of full validation of the method proposed that was performed in accordance with approved national and international technical and regulatory requirements, allowed to affirm high specificity, sensitivity, accuracy, reproducibility and efficiency of the method.Цель. Для изучения биоэквивалентности таблетированной формы силденафила (таблетки «Тегрум» 100 мг), производства ООО «НПФ «Микрохим» (г. Рубежное, Украина) был разработан и валидирован быстрый, простой и специфический метод количественного определения концентрации силденафила и его активного метаболита - N-десметил силденафила в плазме крови человека с применением внутренних стандартов, меченных атомами дейтерия. Извлечение аналитов из плазмы крови выполнялось методом прямой жидкость-жидкостной экстракции.Методы. Содержание силденафила и его десметилированного метаболита определяли в надосадочной жидкости методом высокоэффективной жидкостной хроматографии с тандемным масс-спектрометрическим детектированием. Ионизацию cилденафила, N-десметил силденафила, cилденафила-d8 и N-десметил силденафила-d8 проводили электрораспылением в положительном режиме (ESI, Positive). При детектировании использовали мониторинг мультиреакций (MRM) выбранных материнских ионов с m/z 475,30; 483,20; 461,20; 469,20. Дочерний ион был выбран с m/z 283,10 для всех анализируемых соединений.Результаты. В ходе валидации данного метода в линейном диапазоне 5,05-1009,92 нг/мл для силденафила и 2,24-400,84 нг/мл для N-десметил силденафила коэффициент корреляции (r2) составил 0,9975 и 0,9973 соответственно, также была продемонстрирована надёжная правильность и воспроизводимость результатов для обеих аналитов.Выводы. Разработан и валидирован простой, специфический и чувствительный ВЭЖХ-МС/МС метод количественного определения концентрации силденафила и его активного метаболита N-десметил силденафила в плазме крови человека с применением меченных стабильными изотопами внутренних стандартов - силденафил-d8 и N-десметил силденафил- d8. Разработанный нами экспресс-метод подготовки биологических образцов, позволяет исключить влияние биологической матрицы на получаемые результаты и определять низкие концентрации обоих аналитов в надосадочной жидкости без применения таких трудоемких и времязатратных процедур, как концентрирование пробы, восстановление сухого остатка или дорогостоящей твердофазной экстракции. Экспериментальные данные, полученные в ходе полной валидации метода, соответствуют установленным национальным и международным требованиям, а так же подтверждают высокую специфичность, чувствительность, точность, воспроизводимость и экономичность разработанного нами метода